Provider Demographics
NPI:1982021754
Name:PAULK, ASHLEY RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:PAULK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:P
Other - Last Name:IKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:10758 COUNTY ROAD 64 STE 2
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-6026
Mailing Address - Country:US
Mailing Address - Phone:334-590-2650
Mailing Address - Fax:
Practice Address - Street 1:10758 COUNTY ROAD 64 STE 2
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-6026
Practice Address - Country:US
Practice Address - Phone:334-590-2650
Practice Address - Fax:251-234-3035
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist